Provider Demographics
NPI:1881862183
Name:PETERSON CAVIASCO, KAREN GAIL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GAIL
Last Name:PETERSON CAVIASCO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VANESSA LN
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2711
Mailing Address - Country:US
Mailing Address - Phone:973-962-0901
Mailing Address - Fax:
Practice Address - Street 1:365 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1971
Practice Address - Country:US
Practice Address - Phone:973-951-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048803001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ48193Medicare PIN